Dinah, ClinkShrink, & Roy produce Shrink Rap: a blog by Psychiatrists for Psychiatrists, interested bystanders are also welcome. A place to talk; no one has to listen.

Sunday, May 06, 2007

Community in Uproar After California Psychiatrist Fired

This is an interesting story, not because of the controversy of a psychiatrist being fired and the poor communication about her replacement, but because of the way the community has had so much involvement in the discourse about the whole thing, by way of the Comments section of the local newspaper's online version.

Where? SCHC, Redding, California, in Shasta County. Here's the first few paragraphs from the May 2 story in the Record Searchlight:

A Redding health clinic that serves mostly low-income residents has fired one of its two psychiatrists, leaving hundreds of her patients scrambling to find other care.

The Shasta Community Health Center terminated the contract of clinical psychiatrist Lynne Pappas on Friday, Chief Executive Officer Dean Germano said. A former Shasta County psychiatrist, Pappas had been with the clinic for about four years.

Neither Pappas nor Germano would say what led to her dismissal, but patients said they were told by clinic employees that Pappas had been escorted from the building several weeks ago and suspended after an argument with her supervisor, medical director Dr. Ann Murphy. Murphy did not return a call Tuesday seeking comment.

“It’s an employment matter and the only thing I can say is it was just not working out,” Germano said Monday. “I will say Dr. Pappas in my judgment is a fine physician. It has nothing to do with her competency or care of patients.”

What follows the story is more than 60 comments from the community, mostly skeptical about the reason for the firing, suggesting politics or unwillingness of the departing doctor to cut corners.

You should go read some of the comments; it's really quite an outpouring of support for Dr. Pappas and concern for their family member's follow-up care.

California is currently going thru an evolution in forensic mental health care after a recent court order and prisoner class action lawsuits have required the prisons there to increase the wages paid to forensic mental health providers in order to encourage them to take these jobs. As a result, salaries for psychiatrists in West Coast correctional settings have gone through the roof. This has caused some docs working in community clinics and hospitals to play a Go To Jail card, taking up some of these new positions, which had previously gone unfilled. This is resulting in more difficulties in finding psychiatrists and other mental health professionals to fill community positions, resulting in higher salaries being offered, and breaking county and state budgets.

Lawyers for mentally ill prisoners will ask a federal judge today [Apr 23] to force the state to take drastic action to stem a staff exodus from California's mental hospitals that has jeopardized patient safety and left psychotic inmates to languish in jails and prisons without proper treatment.U.S. District Judge Lawrence K. Karlton in February ordered the state Department of Mental Health to formulate a plan to reverse a staff exodus from the state's beleaguered hospitals in recent months. The staff departures occurred after the same court had ordered raises for prison mental health staff that made prison jobs more attractive than those at hospitals...."The plan … is akin to placing a Band-Aid over a gaping hole in an almost empty bucket of water, while doing nothing to refill the lost water," lawyers for the prisoners wrote, calling the approach a "wait, see, and hope for a miracle" strategy that "is reckless and must be immediately addressed by this court."

It doesn't sound like this current firing has much to do with these dynamics, but it is important to understand the occupational landscape in CA.

Kathryn Ranken, a private therapist in Redding who sees some of Pappas' clients, said it was "unethical" for the clinic to dismiss Pappas without having a plan in place for treating her hundreds of ailing patients.

Pappas wasn't hit by a meteor; she apparently was suspended a few weeks ago after an argument with the clinic's medical director, and she was fired Friday. That left time to make the best of what was bound to be a rocky transition, yet this week the clinic's managers and Shasta County Mental Health were still figuring out how to handle referrals of Pappas' patients.

And we're not talking about just a few people. Pappas and the health center's one other psychiatrist had more than 2,000 patients...

Sounds like Clink's caseload.

It's just really good to see the paper, and reporter Tim Hearden, use Tim's blog as a way of holding a kind of virtual town hall meeting to help resolve this crisis in the community's ability to meet the mental health needs of its members.

(And... this really is Roy... I know the topic sounds real Clinkshrinky.)

5 comments:

Even in more densely populated parts of the state, public mental health care can be really hard to come by.

I've tried to do my part to help; but it seems I'm either underqualified (being pre-licensed) or over-qualified (having a post-graduate degree) to serve people in need.

The new wave seems to be peer-provided services, which I suppose are more cost-effective in the short term than professional services. On the other hand, reducing professional services (including psychiatry and psychological testing) might actually be less cost-effective in the long term, as people may not get the care they need quickly enough.

"Lawyers for mentally ill prisoners will ask a federal judge today [Apr 23] to force the state to take drastic action to stem a staff exodus from California's mental hospitals that has jeopardized patient safety and left psychotic inmates to languish in jails and prisons without proper treatment."

Huh? You increase staffing in the correctional system. You do this by hiring free society doctors. Free society complains that their patients will end up in a system where mental health care services are being improved? This is circular reasoning to the nth degree.

Community psychiatrists can't have it both ways. You can't point fingers at correctional deficiencies but then complain when those deficiencies are addressed.

Mostly positive comments, but you didn't even mention the comment that began with how the doctor nearly killed her son and ended with the recommendation that she go to jail---which other commenters say was unsubstantiated. I found this whole line of comments, both supportive but also potentially career-ending damning in someone who's been escorted off her job, to be worthy of a post in it's own right.

have found Dr. Pappas to be incompetent. The first time I saw her, it was during her private practice. She offered to see me for free, and told me to give my money to someone in need. The next time I went in to see her, she refused to see me, claiming I owed her money. When I saw her at the clinic, I found her to be incompetent aswell. She was unable to help me. When I first saw her there, I specifically stated I did not want a medication that caused nausia and vomitting. She then turns around and prescribes a drug that lists vomitting as it's most common side affect. I told her what medication seemed to work for me, but she wanted to put me on something else, none of which have ever worked. When I was suffering from acid reflux, she prescribed 20 milligrams of Nexium. This did no good. When I saw Dr. Stanfield, he did not know why she prescribed me on such a low dose. He increased it to 40, and the reflux vanished. I have found Dr. Khan to be competant and helpful.

Also, the first time I saw her, she placed me on Ritalin at my own request. Do Dr's normally prescribe medications to patients who ask for what they want? I was never diagnosed with ADD, but that didn't seem to bother her.